Former Democratic President Joe Biden’s administration added the 2024 rule prohibiting disclosure of protected reproductive health information for criminal, civil or administrative investigations to the Health Insurance Portability and Accountability Act or HIPAA. (Connect Images for Getty Images)

A 2024 federal rule that shielded reproductive health information from disclosure to law enforcement when care was legally obtained, such as in another state with abortion access, was struck down by a federal judge in Texas on Wednesday evening.

U.S. District Judge Matthew Kacsmaryk of Texas’s decision applied nationwide, nullifying the rule immediately. Kacsmaryk had temporarily blocked its enforcement against Dr. Carmen Purl, who sued HHS because she said the rule created a conflict with the laws requiring her to report child abuse.

“Striking down this critical rule is cruel,” said Maddy Gitomer, senior counsel at Democracy Forward, in an emailed statement. “The 2024 HIPAA Privacy Rule has helped protect pregnant people and health care providers from invasive government intrusion into private medical information.’’

The rule did not allow disclosure of protected health information for criminal, civil or administrative investigations against any person for the mere act of seeking, obtaining, or facilitating reproductive health care, to impose criminal or civil liabilities for that conduct, or to identify the person involved in seeking or obtaining that care. It also applied to gender-affirming care.

Two other cases challenging the same rule are still pending in federal courts in Tennessee and Missouri, but it’s unclear what  Kacsmaryk’s decision means for those cases, or another Texas lawsuit led by Attorney General Ken Paxton that also seeks to strike down a broader 2000 privacy rule.

Former Democratic President Joe Biden’s administration added the rule to the Health Insurance Portability and Accountability Act, a 30-year-old federal law meant to protect patient health information, especially when that information travels between providers. The law contains exceptions for when information can be disclosed to investigators, who can subpoena records for a law enforcement matter. After the 2022 Dobbs decision returned abortion regulation to the states, prompting more than a dozen to pass abortion bans, advocates worried that such records could be used by state officials and law enforcement to investigate and prosecute patients seeking an abortion and those who help them.

Lauren Paulk, senior research counsel for If/When/How, a nonprofit that provides legal support for reproductive health care, told States Newsroom on Wednesday evening that people are still protected by the federal HIPAA law, including the foundational 2000 privacy law that requires certain procedural steps to be met before records can be subpoenaed. The 2024 rule was meant to provide reassurance to patients who are afraid to seek abortion or gender-affirming care, even where it is legal, by specifically exempting those records.

Kacsmaryk’s decision, she said, will erode trust between patients and providers and potentially damage that relationship. And it could be a sign of more actions to come.  

“There’s a laundry list of things that I think could start to be added here whenever the courts are saying there really aren’t protections for private reproductive health information,” Paulk said.

Democracy Forward, a nonprofit legal organization, filed a filed a motion to intervene earlier in the case on behalf of the cities of Columbus, Ohio, and Madison, Wisconsin, because attorneys said they no longer had faith that the U.S. U.S. Department of Health and Human Services would adequately defend the law under Republican President Donald Trump’s administration. Kacsmaryk denied that motion to intervene, and Democracy Forward appealed that decision to the 5th U.S. U.S. Circuit Court of Appeals. That appeal is pending.

“Vacating this regulation will be detrimental to the privacy rights of pregnant people across the country, and will interfere with the ability of healthcare providers and patients to communicate confidentially and openly about a patient’s health needs,” Gitomer said.

Gitomer said Democracy Forward will continue to explore all of its options to defend reproductive rights from “political interference and anti-abortion extremists.”

Conservative law firm Alliance Defending Freedom represented doctor in Texas judge’s district

Purl is the sole owner of Dr. Purl’s Fast Care Walk In Clinic in Dumas, Texas. In court documents, she said:

“I consider both a pregnant woman and her unborn child to be human persons, and both are entitled to medical care and deserve the protection of the law. I believe … that elective abortions harm patients’ health and public health.”

The location of Purl’s clinic put her in Kacsmaryk’s district, where he is the only judge. Most federal cases are assigned randomly to a group of judges in a district, but since Kacsmaryk, a Trump appointee, is the sole jurist, some advocates and attorneys have accused law firms like Alliance Defending Freedom, who is representing Purl in the case, of “judge shopping.” That phrase refers to finding a plaintiff in a certain area for the purpose of putting it in front of an ideologically friendly judge.

In an earlier high-profile case, Kacsmaryk attempted to order the U.S. Food and Drug Administration to rescind its decades-old approval of mifepristone, one of two drugs used to terminate early pregnancies and treat miscarriages. That decision was eventually returned  by the U.S. Supreme Court to a lower court for consideration.

Officials in Texas have already attempted to investigate women who left the state, which has a near-total abortion ban and other abortion-related laws, to terminate a pregnancy.

In a 65-page opinion, Kacsmaryk said the U.S. Department of Health and Human Services’ leadership under Biden “invoked HIPAA as a shield against abortion-restrictive states.” He determined the rule unlawfully limited disclosures about abuse and public health to state authorities, and said it exceeded statutory authority because it employed HIPAA to impose special rules for abortion. Such action should only be taken by Congress, he said, especially because the issues at hand are of major political significance.

“People of good faith vehemently disagree on both these issues,” Kacsmaryk wrote, referring to abortion and gender-affirming care. “These issues transcend politics, implicating anthropology, philosophy, and concepts of self. … The 2024 rule creates special rules for information about these politically favored procedures that implicate fundamental and hotly debated questions.”

Planned Parenthood has identified 200 of its clinics in 24 states that are at risk of closure through federal cuts under the budget reconciliation package before the U.S. Senate. (Photo by Michael B. Thomas/Getty Images)

If the budget reconciliation package before the U.S. Senate becomes law in the coming weeks, reproductive health advocates say the provision that would cut federal funding to Planned Parenthood clinics could serve as a backdoor nationwide abortion ban, eliminating access to 1 in 4 abortion providers.

The Republican-led bill, which already passed the House by a slim margin, is more than 1,000 pages and includes sweeping tax cuts that mostly benefit the wealthy coupled with steep spending cuts to social services, including Medicaid.

On page 339 of the bill, Republicans included a provision prohibiting Medicaid funding from going to any sexual and reproductive health clinics that provide abortions and received more than $1 million in federal and state Medicaid funding in fiscal year 2024. While there may be a few independent clinics with operating budgets that high, it effectively singles out Planned Parenthood clinics.

Planned Parenthood clinics rely heavily on Medicaid funding, not to provide abortions, which is not permitted by federal law (except in cases of rape, incest or life-threatening health emergencies), but to provide standard reproductive health care at little to no cost, including treatment for sexually transmitted infections and cancer screenings, as well as contraception. Planned Parenthood provides services for about 2 million patients every year, and 64% of its clinics are in rural areas or places with health care provider shortages.

A Planned Parenthood spokesperson said people who use Medicaid make up half of the total patient volume nationwide for essential health care services provided by their clinics. Even though those patients aren’t seeking abortion care, funding cuts would affect the financial sustainability of those clinics, the spokesperson said.

The organization already identified that 200 of its clinics in 24 states are at risk of closure with the cuts but told States Newsroom on Thursday that further analysis revealed nearly all of those clinics — 90% — are in states where abortion is legal, and in 12 states, approximately 75% of abortion-providing Planned Parenthood health centers could close. The entire organization has about 600 clinics in 48 states.

The “One Big Beautiful Bill” would result in nearly 11 million people losing access to health insurance by 2034, according to the nonpartisan Congressional Budget Office, and add $2.4 trillion to the federal deficit over the next 10 years.

Alexis McGill Johnson, president and CEO of Planned Parenthood Action Fund, told States Newsroom she and other advocates have been meeting with senators to lobby against the bill’s passage, emphasizing that it will have an outsized negative effect on rural clinics and hospitals.

“We are encouraging everyone to reach out to their representatives about this,” McGill Johnson said. “They know that they’re doing this under a watchful eye, and we want to make sure their constituents know about it.”

The defunding effort would be a win for several prominent anti-abortion organizations that have long lobbied for this change and nearly achieved it in 2017 with a similar budget bill. Americans United for Life sent a fundraising email to its supporters Thursday saying this is a “crossroads” for abortion in America. 

“So far in 2025 more than a dozen Planned Parenthood clinics have closed, their taxpayer funding is hanging by a thread, and the highest-ranking federal health officials are undertaking a ‘top-to-bottom review’ on the abortion pill,” the email attributed to CEO John Mize said. “It’s possible that very soon, mail-order abortion could be walked back, and more Planned Parenthood locations could be closing their doors for good.”

Susan B. Anthony Pro-Life America, another anti-abortion organization that helped draft the Heritage Foundation’s Project 2025 blueprint for the next Republican president, told States Newsroom in an emailed statement that the budget provision should be no surprise, and there are better uses for the funding, like community health centers.

“Republicans have identified budgetary concerns with funding Big Abortion since 2015, and the bill language to do so has remained substantially the same,” said SBA President Marjorie Dannenfelser.

Closures would affect already fragile health care system, Midwest doctor says

Planned Parenthood has already closed some clinics around the country, including eight clinics across Iowa and Minnesota at the end of May. Dr. Sarah Traxler, chief medical officer of Planned Parenthood North Central States, which includes Iowa and Minnesota, said the U.S. Health and Human Services’ decision to freeze Title X family planning funding to many reproductive health clinics at the beginning of May contributed to the decision to close those clinics. The North Central States affiliates serve more than 93,000 patients each year, about 20,000 of which use telehealth services.

About 30% of those patients use Medicaid to access care, she said.

“When Planned Parenthood isn’t able to provide services to patients as an essential safety net provider, it has ripple effects across the health care system at large,” Traxler said. “We are already sitting in a time in our country, and have for several decades, where we have patients who can’t access care.”

Clare Coleman, president and CEO of the National Family Planning and Reproductive Health Association, told States Newsroom that 865 Title X clinics in 23 states are impacted by the federal freeze. She said there are no Title X services in eight states: California, Hawaii, Maine, Mississippi, Missouri, Montana, Tennessee and Utah. She said the funding freeze affects one-quarter of all Title X funding grantees, translating to about 842,000 patients who have lost access to care.

“In the two months since HHS withheld federal funding for nearly two dozen Title X family planning grants, affected grantees have been struggling with the unknown of whether they will ever receive the vital funds,” Coleman said in an email. “Some have had to close clinics, lay off staff, and reduce essential contraceptive and sexual health care services. … On top of the Title X funding freeze, proposed Medicaid cuts will be devastating for Title X grantees. Rates of unintended pregnancies and STIs will increase, cancer screenings and diagnoses will be delayed, and decades of public health progress will be reversed.”

After the Iowa Legislature axed Planned Parenthood from its family planning program, Traxler said, the rates of sexually transmitted infections increased considerably across the state — an outcome verified by a 2022 medical study. She expects similar effects from these cuts.

People already travel long distances for abortion care, she said, and that will only get worse if more cuts come to pass. But she also expects to see patients start traveling long distances for routine gynecological care.

‘Changes to Medicaid … only adds to the chaos’

Like many independent abortion clinics, the all-trimester Maryland abortion clinic Partners in Abortion Care does not receive Title X funding. But because Maryland is one of 17 states whose Medicaid program covers abortions, they do see a lot of patients who are on Medicaid, at a significant cost to the clinic. Certified nurse-midwife and Partners co-founder Morgan Nuzzo said the clinic did not receive more than $1 million in federal or state Medicaid dollars in fiscal year 2024, and in fact loses about $1 million annually for seeing Medicaid patients.

Nuzzo said Maryland’s Medicaid program reimburses first-trimester abortions at a “decent rate,” but at a very low rate for later abortion cases, which are more medically complex.

“After about 15 to 16 weeks [gestation], we’re losing money on these cases,” Nuzzo said. “We’ve been billing now for almost a year through the state. In second and third-trimester abortion care, we’re losing about 85% of what we would charge for a cash pay fee. So that comes out to about $250,000 a quarter that we are losing just by the under-reimbursement from Maryland Medicaid.”

For that reason, Nuzzo is hopeful about Maryland’s new $25 million Public Health Abortion Grant Program, recently approved by Gov. Wes Moore. The program will be open to clinics like Partners and abortion funds like the Baltimore Abortion Fund, but Nuzzo said it could be a while before that funding is available. Right now she is uncertain and concerned about how the federal reconciliation bill could potentially impact Maryland’s Medicaid program. 

Because Partners provides abortions for all trimesters, they see patients from all over the country, and even the world, and the vast majority need financial assistance, Nuzzo said.

“People are traveling further for their procedures, just like they were before,” she said. “The landscape is constantly changing, almost week to week, about where you can access abortion, which is confusing and chaotic to patients. Changes to Medicaid and insurance coverage of abortion only adds to the chaos.”

A decision is imminent in three of the four cases that will determine whether individual health information for legal reproductive care remains protected by a 2024 federal rule.

Dr. Eve Espey has many stories she can tell about patients who travel to her clinic in New Mexico from their homes in Texas, where abortion laws are some of the most restrictive in the country.

In one recent case, Espey said a patient flew from Texas to Albuquerque for an abortion after her doctor advised that an autoimmune disease she has made being pregnant incredibly dangerous. At the same time, she had an IUD placed as future contraception.

Shortly after returning home, the patient had some cramping and discomfort that prompted her to have the placement of the IUD checked and make sure it hadn’t moved. But her doctor turned her away because she’d had an abortion.

“She flew back to New Mexico to get her IUD examined,” Espey told States Newsroom.

In this case, Espey’s patient voluntarily told her doctor that she’d had an abortion. But if a rule exempting reproductive health information from law enforcement investigations is struck down or altered by one of three federal cases brought by Republican attorneys general from more than a dozen states, that information could become mandatory to disclose.

A decision is imminent in three of the four cases that will determine whether individual health information for legal reproductive care remains protected by a 2024 federal rule under the Health Insurance Portability and Accountability Act (HIPAA), including a case in Texas before the same judge who tried to revoke government approval of an abortion drug.

The plaintiffs in the cases, which include 17 states that heavily restrict or outright ban abortion, say the rule undermines their state rights to investigate waste, fraud and abuse. Chad Kubis, spokesperson for Tennessee Attorney General Jonathan Skrmetti, told States Newsroom via email that the office could not comment because of the ongoing litigation. But the complaint in the case led by Tennessee said, “The final rule will hamper states’ ability to gather information critical to policing serious misconduct like Medicaid billing fraud, child and elder abuse, and insurance-related malfeasance.”

HIPAA is a federal law passed nearly 30 years ago to protect the privacy and security of patient health information, especially as that information travels between clinics in an increasingly all-digital world. It includes some exceptions under limited conditions, such as law enforcement investigations. After the 2022 Dobbs decision returned abortion regulation to the states, prompting more than a dozen to pass abortion bans, advocates worried that such records could be used by state officials and law enforcement to investigate and prosecute patients seeking an abortion and those who help them.

Former Democratic President Joe Biden’s administration sought to remedy those concerns by adding a rule to the HIPAA law in 2024 restricting disclosure of the information. Meanwhile, states with legal abortion passed their own shield laws to protect providers and patients from out-of-state investigations.

In New Mexico, doctors like Espey are protected by a shield law that covers patients, providers and those who help someone obtain an abortion. Even with that, Espey worries and makes sure she’s careful with the notes she puts into writing. Lawmakers in New Mexico have considered going further with the shield law to require patient consent for any release of reproductive health records, but that could become an issue in emergencies.

“That is a colossal barrier to a provider,” Espey said. “Somebody could come into the ER and you can’t access the fact that they had an abortion two days ago.”

Lauren Paulk, senior research counsel for If/When/How, a nonprofit that offers legal support to those seeking reproductive health care, said the rule is important to keep intact because it helps patients and providers feel safe. Without it, more people will be turned away from clinics and hospitals, she said.

“Since Dobbs, there have been documented cases of at least seven people who have died in part because they were afraid to seek care or were denied care. We know that patients see these stories too,” Paulk said. “We also run a help line, so we hear people calling in every day who are scared to seek health care.”

For many years, people have considered health privacy to be a basic right, Paulk said, and have taken it for granted that when they see a doctor, the information shared will be confidential. But she said it’s vital that it stays that way.

“Having the state involved in health care poisons the well of the patient-provider relationship,” Paulk said. “When I go to my health care provider and I can’t be frank with them, it means I’m not going to get care to the extent that I need.”

Since Republican President Donald Trump’s administration took office in January and Secretary Robert F. Kennedy Jr. is now at the helm of U.S. Health and Human Services, the agency that administers the rule, the suits have become more complicated, including how the government is responding to each case.

They are:

State of Missouri v. U.S. Department of Health and Human Services: Republican Missouri Attorney General Andrew Bailey filed this lawsuit in January, claiming that the rule infringes on state powers to investigate fraud, abuse and public health violations. U.S. District Judge John A. Ross, who was appointed by former Democratic President Barack Obama, is weighing the Trump administration’s request to dismiss the case for lack of standing. 

State of Tennessee v. HHS: Republican Tennessee Attorney General Jonathan Skrmetti filed this lawsuit in January, also claiming that the rule infringes on state powers of investigation. Republican attorneys general in 14 other states joined as plaintiffs. U.S. District Judge Katherine A. Crytzer, an appointee of Republican President Donald Trump, has been asked by the Trump administration to dismiss the case for lack of standing or grant the states’ request to block the rule. 

Purl, M.D. v. HHS: Dr. Carmen Purl, the sole owner of Dr. Purl’s Fast Care Walk In Clinic in Dumas, Texas, sued in October because she said the rule creates a conflict with the laws requiring her to report child abuse. The case is before U.S. District Judge Matthew Kacsmaryk, an appointee of Republican President Donald Trump. Kacsmaryk granted a preliminary injunction, but is expected to rule soon on a permanent injunction. 

State of Texas v. HHS: Republican Texas Attorney General Ken Paxton sued in September, claiming the 2024 rule violates state investigative authority. Paxton argued the underlying 2000 HIPAA rule should be struck down as well — a move that could open many more avenues for state investigations if it is granted. U.S. District Judge James Wesley Hendrix, a Trump appointee, has given the federal health agency two extensions of time to decide whether they want to rescind and rewrite the rule.

The judges presiding over the cases in Missouri and Tennessee, as well as the Purl case in Texas, could issue decisions at any time Missouri filed its lawsuit alone, while 14 other states with Republican attorneys general joined Tennessee’s lawsuit as plaintiffs: Alabama, Arkansas, Georgia, Idaho, Indiana, Iowa, Louisiana, Montana, Nebraska, North Dakota, Ohio, South Carolina, South Dakota and West Virginia. All but three of those states either heavily restrict or outright ban abortion, and if the lawsuits are successful, records kept by doctors and pharmacists in other states could be subpoenaed.

If the underlying 2000 HIPAA privacy rule is somehow altered by court rulings in Texas, it could have even more effects, Paulk said. If/When/How receives phone calls from therapists living in states with abortion bans who are afraid of facing criminal charges just for talking about abortion with a patient, or for not reporting a person considering an abortion to the police, she said. That’s not true under existing laws, but if privacy rules change, records like therapy notes could also be subject to investigation.

“It’s clear to me that the folks who are pursuing the overturn of these laws and the folks who are in states where they’re trying to get access to health information are seeking to criminalize people and further stigmatize health care like abortion and gender-affirming care,” Paulk said. “They want people to be afraid to access care and providers to be afraid to provide it, and they’re using this specter of punishment to do that.”

DOJ asked two courts to dismiss Republican-led lawsuits

Democracy Forward, a nonprofit legal organization, is representing the cities of Columbus, Ohio, and Madison, Wisconsin, and Doctors for America, and has attempted to intervene in all four cases — Kacsmaryk denied the request, but the other three are still pending. If any of the motions are granted, attorneys for Democracy Forward could defend the rule, because they do not think the DOJ attorneys will adequately defend it, said Carrie Flaxman, the nonprofit’s senior legal adviser.

The cities and Doctors for America filed a friend-of-the-court brief after Kacsmaryk’s denial, arguing that HIPAA is vital to protecting patient confidentiality, including the 2024 rule.

At the end of March, Trump’s Department of Justice attorneys asked the federal courts in Missouri and Tennessee to dismiss the cases for lack of standing, saying the states have not demonstrated any harm.

“Missouri’s complaint vaguely alleges that the rule impedes state investigations and requires the state to expend resources to comply with the rule’s requirements,” the motion to dismiss says. “But absent from the complaint are any concrete facts supporting these conclusory assertions of harm, which one would expect to see if the rule truly posed the risks that the state alleges.”

In Texas, Kacsmaryk ordered the Department of Justice to provide an update about the health services agency’s review of the Biden-era rule in May, and asked if they wished to pause the court proceedings while they conduct that review. Acting Assistant Attorney General Yaakov Roth told the court in a brief that the rule remains “under consideration” but no imminent action on the rule is expected. He added that they were not requesting any pause in the case.

That response differed in Paxton’s suit, which was already on hold. DOJ attorneys asked for more time to “evaluate the agency’s position in this case and determine how best to proceed.” The judge granted the extension, and another update is expected in July.

“Blocking either or both of these rules could pave the way for government investigations by Attorney General Paxton or others and threaten the foundations of medical privacy that we all rely on,” Flaxman said. “Patients nationwide should be concerned about investigations … into the most personal of their medical records.”